Prosthetic device and method of manufacturing the same

ABSTRACT

A biocompatible surgical silk mesh prosthetic device employs a knit pattern that substantially prevents unraveling and preserves the stability of the mesh device, especially when the mesh device is cut. An example prosthetic device employs a knitted mesh including at least two yarns laid in a knit direction and engaging each other to define a plurality of nodes. The at least two yarns include a first yarn and a second yarn extending between and forming loops about two nodes. The second yarn has a higher tension at the two nodes than the first yarn. The second yarn substantially prevents the first yarn from moving at the two nodes and substantially prevents the knitted mesh from unraveling at the nodes.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. application Ser.No. 13/088,706, filed Apr. 18, 2011, which is a continuation-in-partapplication of U.S. application Ser. No. 12/680,404, filed Sep. 19,2011, which is a national stage application of PCT/US09/63717, filedNov. 9, 2009, which claims priority to and the benefit of U.S.provisional patent application No. 61/122,520, filed Dec. 15, 2008, allof which applications are hereby expressly incorporated by referenceherein in their entireties.

FIELD OF THE INVENTION

The present invention generally relates to a prosthetic device fortissue repair, and, more particularly, to a surgical silk mesh deviceemploying a stable knit structure.

BACKGROUND OF THE INVENTION

Surgical mesh initially used for hernia and abdominal wall defects arenow being used for other types of tissue repair, such as rotator cuffrepair, pelvic floor dysfunction, and reconstructive or cosmeticsurgeries. It is projected that in 2010, there will be more than 8million hernia procedures, 800,000 rotator cuff repairs, 3 millionpelvic prolapse repairs, 600,000 urinary incontinence repairs, and 1.5million reconstructive or aesthetic plastic surgeries. Most of theseprocedures will likely employ implantable surgical mesh devicescurrently on the market, including: Bard Mesh (polypropylene) by C. R.Bard; Dexon (polyglycolic acid) by Synecture/US Surgical; Gore-Tex(polytetraflouroethylene) by W.L. Gore; Prolene (polypropylene), ProleneSoft (polypropylene), Mersilene Mesh (polyester), Gynemesh(polypropylene), Vicryl Knitted Mesh (polyglactin 910), TVT(polypropylene) by Ethicon; Sparc tape (polypropylene) by AmericanMedical Systems; and IVS tape (polypropylene) by TYCO HealthcareInternational.

Surgical mesh devices are typically biocompatible and may be formed frombioresorbable materials and/or non-bioresorbable materials. For example,polypropylene, polyester, and polytetraflouroethylene (PTFE) arebiocompatible and non-bioresorbable, while polyglactin 910 andpolyglycolic acid are biocompatible and bioresorbable.

Though current surgical mesh devices may be formed from differentmaterials, they have various similar physical and mechanicalcharacteristics beneficial for tissue repair. However, despite thebenefits provided by current surgical mesh devices, their use may beaccompanied by a variety of complications. Such complications, forexample, may include scar encapsulation and tissue erosion, persistentinfection, pain, and difficulties associated with revision surgery. Inaddition, the use of an absorbable material may result in reoccurrencedue to rapid resorption of the implant material and loss of strength.

Although polypropylene monofilament may be a highly regarded materialfor surgical mesh devices, polypropylene mesh devices can induce intensescar formations and create a chronic foreign body reaction with theformation of a fibrous capsule, even years after implantation. Minorcomplaints of seromas, discomfort, and decreased wall mobility arefrequent and observed in about half of the patients implanted withpolypropylene mesh devices. Moreover, polypropylene generally cannot beplaced next to the bowel due to the propensity of adhesion formation.

Although the use of multifilament polyester may improve conformity withthe abdominal wall, it is also associated with a variety ofdisadvantages. For example, higher incidences of infection,enterocutaneous fistula formation, and small bowel obstruction have beenreported with the use of multifilament polyester compared to othermaterials. Indeed, the small interstices of the multifilament yarn makeit more susceptible to the occurrence of infection, and thusmultifilament polyester is not commonly used within the United States.

The use of polytetraflouroethylene (PTFE) may be advantageous inminimizing adhesions to the bowel. However, the host tissue encapsulatesthe PTFE mesh, resulting in weak in-growth in the abdominal wall andweaker hernia repair. This material, though not a good mesh material onits own, has found its place as an adhesion barrier.

Absorbable materials, such as Vicryl and Dexon, used for hernia repairhave the advantage of being placed in direct contact with the bowelwithout adhesion or fistula formation. A study has observed that Vicrylhas comparable burst strength to nonabsorbable mesh at three weeks butis significantly weaker at twelve weeks due to a quick absorption rate.Meanwhile, the same study observed that Dexon has more in-growth attwelve weeks with less absorption of the mesh. The concern withabsorbable meshes is that the rate of absorption is variable, possiblyleading to hernia recurrence if the proper amount of new tissue is notthere to withstand the physiologic stresses placed on the hernia defect.

A significant characteristic of a biomaterial is its porosity, becauseporosity is the main determinant for tissue reaction. Pore sizesof >500-600 μm permit in-growth of soft tissue; pore sizes of >200-300μm favor neo-vascularization and allow mono-morphological restitution ofbony defects; pore sizes of <200 μm are considered to be almostwatertight, hindering liquid circulation at physiological pressures; andpores of <100 μm only lead to in-growth of single cell types instead ofbuilding new tissues. Finally, a pore size of <10 μm hinders anyin-growth and increases the chance of infection, sinus tract formation,and encapsulation of the mesh. Bacteria averaging 1 μm in size can hidein the small interstices of the mesh and proliferate while protectedfrom neutrophilic granulocytes averaging 10-15 μm.

Other important physical characteristics for surgical mesh devicesinclude thickness, burst strength, and material stiffness. The thicknessof surgical mesh devices vary according to the particular repairprocedure. For example, current surgical mesh device hernia, pelvicfloor dysfunction, and reconstructive/cosmetic procedures range inthickness from approximately 0.635 mm to 1.1 mm. For rotator cuffrepair, a thickness of 0.4 mm to 5 mm is typically employed.

Intra-abdominal pressures of 10-16 N, with a mean distension of 11-32%results in the need for a surgical mesh with a burst strength that canresist the stress of the inner abdomen before healthy tissue comes intobeing.

Material stiffness is an important mechanical characteristic forsurgical mesh, especially when used for pelvic floor dysfunction,because material stiffness has been associated with the likelihood oftissue erosion. Surgical mesh devices formed from TVT, IVS, Mersilene,Prolene, Gynemesh, Sparc tape, for example, currently have an ultimatetensile strength (UTS) that exceeds the forces exerted byintra-abdominal pressures of 10-16 N. With the low force in the abdomen,the initial stiffness of the material is an important consideration.Moreover, the stiffness may exhibit non-linear behavior most likely dueto changes in the fabric structure, e.g., unraveling of the knit, weave,etc. A surgical mesh device of lesser stiffness may help reduce tissueerosion and may conform to the contours of the body more effectively.

SUMMARY OF THE INVENTION

In view of the disadvantages of current surgical mesh devices, therecontinues to be a need for a surgical mesh that is biocompatible andabsorbable, has the ability to withstand the physiological stressesplaced on the host collagen, and minimizes tissue erosion, fistulas, oradhesions. Thus, embodiments according to aspects of the presentinvention provide a biocompatible surgical silk mesh prosthetic devicefor use in soft and hard tissue repair. Examples of soft tissue repairinclude hernia repair, rotator cuff repair, cosmetic surgery,implementation of a bladder sling, or the like. Examples of hard tissuerepair, such as bone repair, involve reconstructive plastic surgery,ortho trauma, or the like. Thus, the mesh device of the presentinvention is suitable for use in a variety or reconstructive or supportapplications including, but not limited to, breast reconstruction,mastoplexy, breast augmentation revision, breast augmentation support,standard breast augmentation, chest wall repair, organ support, bodycontouring, abdominoplasty, facial reconstruction, hernia repair, andpelvic floor repair.

Advantageously, the open structure of these embodiments allows tissuein-growth while the mesh device degrades at a rate which allows for asmooth transfer of mechanical properties to the new tissue from the silkscaffold. According to a particular aspect of the present invention,embodiments employ a knit pattern, referred to as a “node-lock” design.The “node-lock” design substantially prevents unraveling and preservesthe stability of the mesh device, especially when the mesh device iscut.

In a particular embodiment, a prosthetic device includes a knitted meshincluding at least two yarns laid in a knit direction and engaging eachother to define a plurality of nodes, the at least two yarns including afirst yarn and a second yarn extending between and forming loops abouttwo nodes, the second yarn having a higher tension at the two nodes thanthe first yarn, the second yarn substantially preventing the first yarnfrom moving at the two nodes and substantially preventing the knittedmesh from unraveling at the nodes.

In an example of this embodiment, the first yarn and the second yarn areformed from different materials. In another example of this embodiment,the first yarn and the second yarn have different diameters. In furtherembodiments, wherein the first yarn and the second yarn have differentelastic properties. In yet a further example of this embodiment, the atleast two yarns are formed from silk.

In another example of this embodiment, a first length of the first yarnextends between the two nodes and a second length of the second yarnextends between the two nodes, the first length being greater than thesecond length. For instance, the first yarn forms an intermediate loopbetween the two nodes and the second yarn does not form a correspondingintermediate loop between the two nodes. The first length of the firstyarn is greater than the second length of the second yarn.

In yet another example of this embodiment, the first yarn is included ina first set of yarns and the second yarn is included in a second set ofyarns, the first set of yarns being applied in a first wale direction,each of the first set of yarns forming a first series of loops at eachof a plurality of courses for the knitted mesh, the second set of yarnsbeing applied in a second wale direction, the second wale directionbeing opposite from the first wale direction, each of the second set ofyarns forming a second series of loops at every other of the pluralityof courses for the knitted mesh, the first set of yarns interlacing withthe second set of yarns at the every other course to define the nodesfor the knitted mesh, the second set of yarns having a greater tensionthan the first set of yarns, the difference in tension substantiallypreventing the knitted mesh from unraveling at the nodes.

In a further example of this embodiment, the first yarn is included in afirst set of yarns and the second yarn is included in a second set ofyarns, the first set of yarns and the second set of yarns beingalternately applied in a wale direction to form staggered loops, thefirst set of yarns interlacing with the second set of yarns to definethe nodes for the knitted mesh, the alternating application of the firstset of yarns and the second set of yarns causing the first set of yarnsto have different tensions relative to the second set of yarns at thenodes, the difference in tension substantially preventing the knittedmesh from unraveling at the nodes.

In yet a further example of this embodiment, the first yarn is includedin a first set of yarns and the second yarn is included in a second setof yarns, the first set of yarns forming a series of jersey loops alongeach of a first set of courses for a knitted mesh, the second set ofyarns forming a second series of alternating tucked loops and jerseyloops along each of a second set of courses for the knitted mesh, thesecond set of courses alternating with the first set of courses, thesecond set of yarns having a greater tension than the first set ofyarns, the tucked loops of the second set of yarns engaging the jerseyloops of the first set of yarns to define nodes for the knitted mesh,the tucked loops substantially preventing the knitted mesh fromunraveling at the nodes.

In another particular embodiment, a method for making a knitted mesh fora prosthetic device, includes: applying a first set of yarns in a firstwale direction on a single needle bed machine, each of the first set ofyarns forming a first series of loops at each of a plurality of coursesfor a knitted mesh; applying a second set of yarns in a second waledirection on the single needle bed machine, the second wale directionbeing opposite from the first wale direction, each of the second set ofyarns forming a second series of loops at every other of the pluralityof courses for the knitted mesh; and applying a third set of yarns inevery predetermined number of courses for the knitted mesh, theapplication of the third set of yarns defining openings in the knittedmesh, wherein the first set of yarns interlaces with the second set ofyarns at the every other course to define nodes for the knitted mesh,and the second set of yarns has a greater tension than the first set ofyarns, the difference in tension substantially preventing the knittedmesh from unraveling at the nodes.

In yet another embodiment, a method for making a knitted mesh for aprosthetic device, includes: applying a first set of yarns to a firstneedle bed of a double needle bed machine in a wale direction; applyinga second set of yarns to a second needle bed of the double needle bedmachine in a wale direction; and applying a third set of yarns in everypredetermined number of courses for the knitted mesh, the application ofthe third set of yarns defining openings in the knitted mesh, whereinthe first set of yarns and the second set of yarns are alternatelyapplied to form staggered loops at the first needle bed and the secondneedle bed, respectively, and the first set of yarns interlaces with thesecond set of yarns to define nodes for the knitted mesh, thealternating application of the first set of yarns and the second set ofyarns causing the first set of yarns to have a different tensionrelative to the second set of yarns at the nodes, the difference intension substantially preventing the knitted mesh from unraveling at thenodes.

In a further particular embodiment, a method for making a knitted meshfor a prosthetic device, includes: forming, on a flat needle bedmachine, a first series of jersey loops along each of a first set ofcourses for a knitted mesh; and forming, on the flat needle bed machine,a second series of alternating tucked loops and jersey loops along eachof a second set of courses for the knitted mesh, the second set ofcourses alternating with the first set of courses; wherein the secondset of courses has a greater tension than the first set of courses, andthe tucked loops along the second set of courses engage the jersey loopsof the first set of courses and substantially prevents the knitted meshfrom unraveling at the tucked loops. In an example of this embodiment, acontinuous yarn forms the first set of courses and the second set ofcourses. In another example of this embodiment, the first set of coursesand the second set of courses are formed by different yarns. In yetanother example of this embodiment, the first set of courses and thesecond set of courses are formed by different yarns having differentdiameters.

These and other aspects of the present invention will become moreapparent from the following detailed description of the preferredembodiments of the present invention when viewed in conjunction with theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates the technical back of an example mesh produced on asingle needle bed warp knitting machine according to aspects of thepresent invention.

FIG. 1B illustrates the technical front of the example mesh illustratedin FIG. 1A.

FIGS. 2A and 2B illustrate an example mesh produced on a double needlebed warp knitting machine according to aspects of the present invention.

FIG. 3 illustrates an example mesh produced with single filament silkyarn according to aspects of the present invention.

FIG. 4 illustrates an example mesh produced on a single needle bed warpknitting machine according to aspects of the present invention.

FIG. 5A illustrates an example mesh produced on a double needle bed warpknitting machine, the example mesh having a parallelepiped pore with asection demonstrating a plush design according to aspects of the presentinvention.

FIG. 5B illustrates an example mesh produced on a double needle bed warpknitting machine, the example mesh having a hexagonal pore according toaspects of the present invention.

FIGS. 6A and 6B illustrate example narrow mesh fabrics of varying stitchdensities incorporating a plush variation according to aspects of thepresent invention.

FIG. 7 illustrates an example mesh incorporating loop pile according toaspects of the present invention.

FIG. 8 illustrates an example narrow mesh fabric with pore designachieved through variation in the yarn feed rate according to aspects ofthe present invention.

FIG. 9A illustrates an example collapsed mesh fabric with hexagonalshaped pores according to aspects of the present invention.

FIG. 9B illustrates an example opened mesh fabric with hexagonal shapedpores according to aspects of the present invention.

FIG. 10 illustrates an example of a stable, non-collapsible,hexagonal-shaped porous mesh fabric according to aspects of the presentinvention.

FIG. 11A illustrates an example of a three-dimensional mesh with thesame technical front and technical back according to aspects of thepresent invention.

FIG. 11B illustrates the 2.55 mm thickness of the examplethree-dimensional mesh of FIG. 11A.

FIG. 12 illustrates an example of a three-dimensional mesh with athickness of 3.28 mm according to aspects of the present invention.

FIG. 13A illustrates the technical front of an example non-porous meshaccording to aspects of the present invention.

FIG. 13B illustrates the technical back of the example non-porous meshof FIG. 13A.

FIG. 13C illustrates the 5.87 mm thickness of the example non-porousmesh of FIG. 13A.

FIG. 14A illustrates an example of a three-dimensional mesh with thesame technical front and technical back according to aspects of thepresent invention.

FIG. 14B illustrates the 5.36 mm thickness of the examplethree-dimensional mesh of FIG. 14A.

FIG. 15A illustrates the technical front of an example three-dimensionalmesh fabric according to aspects of the present invention.

FIG. 15B illustrates the technical back of the example three-dimensionalmesh fabric of FIG. 15A.

FIG. 16 illustrates an example mesh produced on a double needle bed weftknitting machine demonstrating shaping of the mesh for a breast supportapplication according to aspects of the present invention.

FIG. 17 illustrates another example mesh produced on a double needle bedweft knitting machine demonstrating shaping of the mesh for a breastsupport application according to aspects of the present invention.

FIG. 18 illustrates yet another example mesh produced on a double needlebed weft knitting machine demonstrating shaping of the mesh for a breastsupport application according to aspects of the present invention.

FIG. 19 illustrates a further mesh produced on a double needle bed weftknitting machine demonstrating shaping of the mesh for a breast supportapplication according to aspects of the present invention.

FIG. 20 illustrates another example mesh produced on a double needle bedweft knitting machine demonstrating shaping of the mesh for a breastsupport application according to aspects of the present invention.

FIG. 21A illustrates a full-thickness rat abdominal defect created usinga custom designed 1-cm stainless steel punch, the defect appearing ovalin shape due to body wall tension applied.

FIG. 21B illustrates a 4 cm×4 cm example implant centered on top of theopen defect of FIG. 21A, and held in place with single interruptedpolypropylene sutures (arrow) through the implant and muscle.

FIG. 21C illustrates an explanted specimen 94 days post implantation asshown in FIG. 21B.

FIG. 21D illustrates ball burst testing performed with a 1-cm diameterball pushed through the defect site reinforced with the mesh accordingto aspects of the present invention.

FIG. 22 illustrates an example pattern layout for a single needle bedmesh according to aspects of the present invention.

FIG. 23 illustrates an example pattern layout for a single needle bedmesh according to aspects of the present invention.

FIG. 24 illustrates an example pattern layout for a single needle bedmesh according to aspects of the present invention.

FIG. 25 illustrates an example pattern layout for the single needle bedmesh according to aspects of the present invention.

FIG. 26 illustrates an example pattern layout of the double needle bedmesh according to aspects of the present invention.

FIG. 27 illustrates an example pattern layout for the double needle bedweft knitting machine according to aspects of the present invention.

FIG. 28A is a photograph of a pattern layout for a silk-based meshdesign in accordance with aspects of the present invention.

FIGS. 28B and 28C illustrate an example pattern layout for the meshdesign of FIG. 28A including all pattern and ground bars according toaspects of the present invention.

FIGS. 28D and 28E illustrate an example pattern layout for a doubleneedle bed mesh or scaffold according to aspects of the presentinvention from FIG. 28B for ground bar #4.

FIGS. 28F and 28G illustrate an example pattern layout for a doubleneedle bed mesh or scaffold according to aspects of the presentinvention from FIG. 28B for pattern bar #5.

FIGS. 28H and 28I illustrate an example pattern layout for a doubleneedle bed mesh or scaffold according to aspects of the presentinvention from FIG. 28B for ground bar #7.

FIG. 28J illustrates an example pattern simulation for a double needlebed mesh demonstrated in FIG. 28B according to aspects of the presentinvention.

FIG. 29A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

FIGS. 29B and 29C illustrate an example pattern layout for the meshdesign of FIG. 29A including all pattern and ground bars according toaspects of the present invention.

FIGS. 29D and 29E are enlarged views of the example pattern layout andground bars of FIG. 29B.

FIGS. 30A and 30B illustrate an example pattern layout for a doubleneedle bed mesh or scaffold according to aspects of the presentinvention from FIG. 29B for ground bar #4.

FIGS. 30C and 30D are enlarged views of the example pattern layout andground bars of FIG. 29B.

FIGS. 31A and 31B illustrate an example pattern layout for a doubleneedle bed mesh or scaffold according to aspects of the presentinvention from FIG. 29B for pattern bar #5.

FIGS. 31C and 31D are enlarged views of the example pattern layout andground bars of FIG. 29B.

FIGS. 32A and 32B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.29B for ground bar #7.

FIGS. 32C and 32D are enlarged views of the example pattern layout andground bars of FIG. 29B.

FIG. 33 illustrates an example pattern simulation for a double needlebed mesh demonstrated in FIG. 29B according to aspects of the presentinvention.

FIG. 34A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

FIGS. 34B and 34C illustrate an example pattern layout for a silk-basedmesh design of FIG. 34A for use as a mesh in accordance with aspects ofthe present invention including all pattern and ground bars according toaspects of the present invention.

FIGS. 34D and 34E are enlarged views of the example pattern layout andground bars of FIG. 34B.

FIGS. 35A and 35B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.34B for ground bar #2.

FIGS. 35C and 35D are enlarged views of the example pattern layout andground bars of FIG. 34B.

FIGS. 36A and 36B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.34B for pattern bar #4.

FIGS. 36C and 36D are enlarged views of the example pattern layout andground bars of FIG. 34B.

FIGS. 37A and 37B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.34B for pattern bar #5.

FIGS. 37C and 37D are enlarged views of the example pattern layout andground bars of FIG. 34B.

FIGS. 38A and 38B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.34B for ground bar #7.

FIGS. 38C and 38D are enlarged views of the example pattern layout andground bars of FIG. 34B.

FIG. 39 illustrates an example pattern simulation for a double needlebed mesh demonstrated in FIG. 34B according to aspects of the presentinvention.

FIG. 40A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

FIGS. 40B and 40C illustrate an example pattern layout for thesilk-based mesh design of FIG. 40A in accordance with the presentinvention including all pattern and ground bars according to aspects ofthe present invention.

FIGS. 40D and 40E are enlarged views of the example pattern layout andground bars of FIG. 40B.

FIG. 41A and FIG. 41B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.40B for ground bar #4.

FIGS. 41C and 41D are enlarged views of the example pattern layout andground bars of FIG. 40B.

FIGS. 42A and 42B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.40B for pattern bar #5.

FIGS. 42C and 42D are enlarged views of the example pattern layout andground bars of FIG. 40B.

FIGS. 43A and 43B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.40B for ground bar #7.

FIGS. 43C and 43D are enlarged views of the example pattern layout andground bars of FIG. 40B.

FIG. 44 illustrates an example pattern simulation for a double needlebed mesh demonstrated in FIG. 40B according to aspects of the presentinvention.

FIG. 45A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

FIGS. 45B and 45C illustrate an example pattern layout for thesilk-based mesh design of FIG. 45A in accordance with the presentinvention including all pattern and ground bars according to aspects ofthe present invention.

FIGS. 45D and 45E are enlarged views of the example pattern layout andground bars of FIG. 45B.

FIGS. 46A and 46B illustrate an example pattern layout for a doubleneedle bed mesh or scaffold according to aspects of the presentinvention from FIG. 45B for ground bar #4.

FIGS. 46C and 46D are enlarged views of the example pattern layout andground bars of FIG. 45B.

FIGS. 47A and 47B illustrate an example pattern layout for a doubleneedle bed mesh or scaffold according to aspects of the presentinvention from FIG. 45B for pattern bar #5.

FIGS. 47C and 47D are enlarged views of the example pattern layout andground bars of FIG. 45B.

FIGS. 48A and 48B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.45B for ground bar #7.

FIGS. 48C and 48D are enlarged views of the example pattern layout andground bars of FIG. 45B.

FIG. 49 illustrates an example pattern simulation for a double needlebed mesh demonstrated in FIG. 45B according to aspects of the presentinvention.

FIG. 50A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

FIGS. 50B and 50C illustrate an example pattern layout for thesilk-based mesh design of FIG. 50A in accordance with the presentinvention including all pattern and ground bars according to aspects ofthe present invention.

FIGS. 50D and 50E are enlarged views of the example pattern layout andground bars of FIG. 50B.

FIGS. 51A and 51B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.50B for ground bar #4.

FIGS. 51C and 51D are enlarged views of the example pattern layout andground bars of FIG. 50B.

FIGS. 52A and 52B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.50B for pattern bar #5.

FIGS. 52C and 52D are enlarged views of the example pattern layout andground bars of FIG. 50B.

FIGS. 53A and 53B illustrate an example pattern layout for a doubleneedle bed mesh according to aspects of the present invention from FIG.50B for ground bar #7.

FIGS. 53C and 53D are enlarged views of the example pattern layout andground bars of FIG. 50B.

FIG. 54 illustrates an example pattern simulation for a double needlebed mesh demonstrated in FIG. 50B according to aspects of the presentinvention.

DETAILED DESCRIPTION

Embodiments according to aspects of the present invention provide abiocompatible surgical silk mesh device for use in soft or hard tissuerepair. Examples of soft tissue repair include hernia repair, rotatorcuff repair, cosmetic surgery, implementation of a bladder sling, or thelike. Examples of hard tissue repair, such as bone repair, involvereconstructive plastic surgery, ortho trauma, or the like.

Advantageously, the open structure of these embodiments allows tissuein-growth while the mesh bioresorbs at a rate which allows for a smoothtransfer of mechanical properties to the new tissue from the silkscaffold. Furthermore, embodiments employ a knit pattern thatsubstantially prevents unraveling, especially when the mesh device iscut. In particular, embodiments may preserve the stability of the meshdevice by employing a knit pattern that takes advantage of variations intension between at least two yarns laid in a knit direction. Forexample, a first yarn and a second yarn may be laid in a knit directionto form “nodes” for a mesh device. The knit direction for the at leasttwo yarns, for example, may be vertical during warp knitting orhorizontal during weft knitting. The nodes of a mesh device, also knownas intermesh loops, refer to intersections in the mesh device where thetwo yarns form a loop around a knitting needle. In some embodiments, thefirst yarn is applied to include greater slack than the second yarn, sothat, when a load is applied to the mesh device, the first yarn is undera lower tension than the second device. A load that places the at leasttwo yarns under tension may result, for example, when the mesh device issutured or if there is pulling on the mesh device. The slack in thefirst yarn causes the first yarn to be effectively larger in diameterthan the second yarn, so that the first yarn experiences greaterfrictional contact with the second yarn at a node and cannot move, or is“locked,” relative to the second yarn. Accordingly, this particular knitdesign may be referred to as a “node-lock” design.

In general, node-lock designs according to aspects of the presentinvention employ at least two yarns under different tensions, where ahigher tension yarn restricts a lower tension yarn at the mesh nodes.The at least two yarns thus differentially engage each other in adefined pattern to form a plurality of interconnections at each of whichthe yarns lockingly engage. To achieve variations in tension betweenyarns, other node-lock designs may vary the yarn diameter, the yarnmaterials, the yarn elastic properties, and/or the knit pattern suchthat the yarns are differentially engaged. For example, the knit patterndescribed previously applies yarns in varying lengths to create slack insome yarns so that they experience less tension. Because the lowertension yarn is restricted by the higher tension yarn, node-lock designssubstantially prevent unraveling of the mesh or disengagement of theyarns from each other when tension is applied to the fabric when themesh is cut. As such, the embodiments allow the mesh device to be cut toany shape or size while maintaining the stability of the mesh device. Inaddition, node-lock designs provide a stability that makes it easy topass the mesh device through a cannula for laparoscopic or arthroscopicsurgeries without damaging the material.

Although the node-lock design may employ a variety of polymer materials,a mesh device using silk according to aspects of the present inventioncan bioresorb at a rate sufficient to allow tissue in-growth whileslowly transferring the load-bearing responsibility to the nativetissue. Particular embodiments may be formed from Bombyx mori silkwormsilk fibroin. The raw silk fibers have a natural globular proteincoating known as sericin, which may have antigenic properties and mustbe depleted before implantation. Accordingly, the yarn is taken througha depletion process. The depletion of sericin is further described, forexample, by Gregory H. Altman et al., “Silk matrix for tissue engineeredanterior cruciate ligaments,” Biomaterials 23 (2002), pp. 4131-4141, thecontents of which are incorporated herein by reference. As a result, thesilk material used in the device embodiments contains substantially nosensitizing agents, in so far as can be measured or predicted withstandardized biomaterials test methods.

A surgical mesh device according to aspects of the present invention maybe created on a single needle bed Comez Acotronic/600-F or a Comez 410ACO by the use of three movements as shown in the pattern layout 2200 inFIG. 22: two movements in the wale direction, the vertical directionwithin the fabric, and one in the course direction, the horizontaldirection of the fabric. The movements in the wale direction go inopposing directions; a first yarn moving in one direction loops everycourse while the second yarn moving in the opposite direction loopsevery other course. The yarns follow a repeated pattern of 3-1 and1-1/1-3 on a 20 gauge knitting machine, using only half of the needlesavailable on the needle bed. The interlacing of the loops within thefabric allow for one yarn to become under more tension than the otherunder stress, locking it around the less tensioned yarn; keeping thefabric from unraveling when cut. The other movement within the fabricoccurs in every few courses creating the openings in the mesh. Theseyarns follow a pattern of 1-9/9-7/7-9/9-1/1-3/3-1. These yarns createtension within the fabric when under stress, locking the yarns in thefabric; preventing the fabric from unraveling.

A surgical mesh device according to aspects of the present invention maybe created on a double needle bed Comez DNB/EL-800-8B knitting machineby the use of three movements as shown in the pattern layout 2600 inFIG. 26: two movements in the wale direction and one in the coursedirection. The two movements in the wale direction occur on separateneedle beds with alternate yarns; loops that occur in every coursemovement are staggered within the repeat. The yarns follow a repeatedpattern of 3-1/1-1/1-3/3-3 and 1-1/1-3/3-3/3-1. The third movementhappens with the yarn that traverses the width of the fabric. The yarnfollows the pattern 9-9/9-9/7-7/9-9/7-7/9-9/1-1/1-1/3-3/1-1/3-3/1-1.This fabric is also made at half gauge on a 20 gauge knitting machineand prevents unraveling due to the tension created between the yarnswhen stressed. The repeat the yarn follows within the pattern isillustrated in FIG. 26.

According to the pattern layouts 2300, 2400, and 2500 illustrated inFIGS. 23, 24 and 25, respectively, variations of the surgical meshpattern are demonstrated for the Single Needle Bed including knittingwith an added warp bar in place of using a weft bar insertion. Thesevariations include knitting with the node lock yarns while moving itperpendicularly to one or more wales. These variations may include, butare not limited to, knitting either an open or closed chain stitch ineither all or alternating courses. Utilizing a third warp bar, asopposed to a weft bar insertion can also be applied to the double needlewarp knitting machine.

A surgical mesh device according to aspects of the present invention maybe formed on the Shima Seiki flat needle bed machine as shown in thepattern layout 2700 in FIG. 27. This knit includes a continuous yarn orat least two different yarn sizes, one of which could be, though notlimited to a different material. The knitted mesh would be formed by aregular jersey knit on the first row with loops formed by either acontinuous yarn or a yarn of a certain yarn size, while the loops in thesecond row are formed by tucked loops that occur alternately with jerseyknit loops of the same continuous yarn or with a yarn of a differentsize. The mesh would be shaped during knitting by use of increasing ordecreasing stitches; a fashioning technique.

In embodiments employing silk yarn, the silk yarn may be twisted fromyarn made by 20-22 denier raw silk fibers approximately 40 to 60 μm indiameter. Preferably, raw silk fibers ranging from 10 to 30 denier maybe employed; however any fiber diameters that will allow the device toprovide sufficient strength to the intended area are acceptable.Advantageously, a constant yarn size may maximize the uniformity of thesurgical mesh mechanical properties, e.g. stiffness, elongation, etc.,physical and/or biological properties. However, the yarn size may bevaried in sections of the surgical mesh in order to achieve differentmechanical, physical and/or biological characteristics in the preferredsurgical mesh locations. Factors that may influence the size of the yarninclude, but are not limited to: ultimate tensile strength (UTS); yieldstrength, i.e. the point at which yarn is permanently deformed; percentelongation; fatigue and dynamic laxity (creep); bioresorption rate; andtransfer of cell/nutrients into and out of the mesh. The knit patternlayouts 2200, 2300, 2400, 2500, and 2600 illustrated in FIGS. 22-26,respectively, may be knitted to any width limited by the knittingmachine width and could be knitted with any of the gauges available withthe various crochet machine or warp knitting machine. TABLE 2 outlinesthe fabric widths that may be achieved using different numbers ofneedles on different gauge machines. It is understood that thedimensions in TABLE 1 are approximate due to the shrink factor whichdepends on stitch design, stitch density, and yarn size used.

TABLE 1 Gauge Needle Count Knitting Width 48 2-5,656 0.53-2,997.68 mm 242-2,826 1.06-2,995.56 mm 20 2-2,358 1.27-2,994.66 mm 18 2-2,1231.41-2,993.43 mm 16 2-1,882 1.59-2,992.38 mm 14 2-1,653 1.81-2,991.93 mm12 2-1,411 2.12-2,991.32 mm 10 2-1,177 2.54-2,989.58 mm 5 2-586  5.08-2,976.88 mm

Embodiments of a prosthetic device according to the present inventionmay be knitted on a fine gauge crochet knitting machine. A non-limitinglist of crochet machines capable of manufacturing the surgical meshaccording to aspects of the present invention are provided by: ChangdeTextile Machinery Co., Ltd.; Comez; China Textile Machinery Co., Ltd.;Huibang Machine; Jakkob Muller AG; Jingwei Textile Machinery Co., Ltd.;Zhejiang Jingyi Textile Machinery Co., Ltd.; Dongguan Kyang the DelicateMachine Co., Ltd.; Karl Mayer; Sanfang Machine; Sino Techfull; SuzhouHuilong Textile Machinary Co., Ltd.; Taiwan Giu Chun Ind. Co., Ltd.;Zhangjiagang Victor Textile; Liba; Lucas; Muller Frick; and Texma.

Embodiments of a prosthetic device according to the present inventionmay be knitted on a fine gauge warp knitting machine. A non-limitinglist of warp knitting machines capable of manufacturing the surgicalmesh according to aspects of the present invention are provided by:Comez; Diba; Jingwei Textile Machinery; Liba; Lucas; Karl Mayer; MullerFrick; Runyuan Warp Knitting; Taiwan Giu Chun Ind.; Fujian XingangTextile Machinery; and Yuejian Group.

Embodiments of a prosthetic device according to the present inventionmay be knitted on a fine gauge flat bed knitting machine. A non-limitinglist of flat bed machines capable of manufacturing the surgical meshaccording to aspects of the present invention are provided by: AroundStar; Boosan; Cixing Textile Machine; Fengshen; Flying Tiger Machinary;Fujian Hongqi; G & P; Görteks; Jinlong; JP; Jy Leh; Kauo Heng Co., Ltd.;Matsuya; Nan Sing Machinery Limited; Nantong Sansi Instrument; ShimaSeiki; Nantong Tianyuan; and Ningbo Yuren Knitting.

FIGS. 1-20 illustrate example meshes produced according to aspects ofthe present invention. Referring to FIGS. 1A and B, an example mesh 100is produced on a single needle bed warp knitting machine according toaspects of the present invention. FIG. 1A shows the technical back 100Aof the mesh 100, and FIG. 1B shows the technical front 100B of the mesh100.

Referring to FIGS. 2A and B, an example mesh 200 is produced on a doubleneedle bed warp knitting machine according to aspects of the presentinvention. FIG. 2A shows the technical front 200A of the mesh 200, andFIG. 2B shows the technical back 200B of the mesh 200.

FIG. 3 illustrates an example mesh 300 produced with single filamentsilk yarn according to aspects of the present invention.

FIG. 4 shows an example mesh 400 produced on a single needle bed warpknitting machine according to aspects of the present invention.

FIG. 5A illustrates an example mesh 500A produced on a double needle bedwarp knitting machine. The mesh 500A has a parallelepiped pore with asection demonstrating a plush design according to aspects of the presentinvention. Meanwhile, FIG. 5B illustrates an example mesh 500B producedon a double needle bed warp knitting machine. The example mesh 500B hasa hexagonal pore according to aspects of the present invention.

FIGS. 6A and B illustrate example narrow mesh fabrics 600A and 600Baccording to aspects of the present invention. The mesh fabrics 600A and600B have varying stitch densities incorporating a plush variation.

Referring to FIG. 7, an example mesh 700 incorporates loop pileaccording to aspects of the present invention. FIG. 8 illustrates anexample narrow mesh fabric 800 with pore design achieved throughvariation in the yarn feed rate according to aspects of the presentinvention.

FIG. 9A illustrates an example collapsed mesh fabric 900A withhexagonal-shaped pores according to aspects of the present invention.Meanwhile, FIG. 9B illustrates an example opened mesh fabric 900B withhexagonal shaped pores according to aspects of the present invention.

As shown in FIG. 10, an example of a stable, non-collapsible mesh fabric1000 includes hexagonal-shaped pores according to aspects of the presentinvention.

FIG. 11A illustrate an example three-dimensional mesh 1100 with the sametechnical front and technical back according to aspects of the presentinvention. FIG. 11B illustrates the 2.55 mm thickness of thethree-dimensional mesh 1100. FIG. 12 illustrates another examplethree-dimensional mesh 1200 with a thickness of 3.28 mm according toaspects of the present invention.

FIGS. 13A-C illustrate an example non-porous mesh 1300 according toaspects of the present invention. FIG. 13A shows the technical front1300A of the non-porous mesh 1300. FIG. 13B shows the technical back1300B of the non-porous mesh 1300. FIG. 13C shows that non-porous mesh1300 has a thickness of 5.87 mm.

FIG. 14A illustrates an example three-dimensional mesh 1400 with thesame technical front and technical back according to aspects of thepresent invention. FIG. 14B shows that the three-dimensional mesh 1400has a thickness of approximately 5.36 mm. FIGS. 15A and B illustrateanother example three-dimensional mesh fabric 1500 according to aspectsof the present invention. FIG. 15A shows the technical front 1500A ofthe fabric 1500, and FIG. 15B illustrates the technical back 1500B ofthe fabric 1500.

FIGS. 16-20 illustrate respective example meshes 1600, 1700, 1800, 1900,and 2000 that are produced on a double needle bed weft knitting machine.The meshes 1600, 1700, 1800, 1900, and 2000 demonstrate shaping of amesh for a breast support application according to aspects of thepresent invention.

FIG. 28A is a photograph of a pattern layout for a silk-based meshdesign suitable for use as a mesh in accordance with aspects of thepresent invention.

One example mesh in accordance with aspects of the present invention ispreferably formed on a raschel knitting machine such as ComezDNB/EL-800-8B set up in 10 gg needle spacing by the use of threemovements as shown in pattern layout in FIGS. 28B and C: two movementsin the wale direction, the vertical direction within the fabric, and onemovement in the course direction, the horizontal direction of thefabric. The movements in the wale direction occur on separate needlebeds with alternate yarns; loops that occur on every course arestaggered within repeat. The yarn follows a repeat pattern of3/1-1/1-1/3-3/3 for one of the wale direction movements as shown inFIGS. 28D and E and 1/1-1/3-3/3-3/1 for the other wale directionmovement as shown in FIGS. 28H and I. The interlacing of the loopswithin the fabric allows for one yarn to become under more tension thanthe other under stress, locking it around the less tensioned yarn;keeping the fabric from unraveling when cut. The other movement in thecourse direction as shown in FIGS. 28F and 28G occurs in every fewcourses creating the porous design of the mesh. These yarns follow arepeat pattern of9/9-9/9-7/7-9/9-7/7-9/9-7/7-9/9-7/7-9/9/-1/1-1/1-3/3-1/1-3/3-1/1-3/3-1/1-3/3-1/1for the course direction movement. The pattern simulation layout of thispattern is rendered with ComezDraw 3 software in FIG. 28J considering ayarn design made with 2 ends of Td (denier count) 20/22 raw silk twistedtogether in the S direction to form a ply with 6 tpi (turns per inch)and further combining three of the resulting ply with 3 tpi. The sameyarn design is used for the movements occurring in the wale and coursedirections. The stitch density or pick count for the mesh in FIG. 28J is34 picks per centimeter considering the total picks count for thetechnical front face and the technical back face of the fabric, or 17picks per cm considering only on the face of the fabric. The operatingparameters are not limited to those described in FIG. 28B-I, but justthe optimum values for the specific yarn design used for the patternsimulation layout of FIG. 28J.

FIG. 29A illustrates a photograph of a pattern layout for a silk-basedmesh in accordance with aspects of the present invention.

One variation of the mesh in accordance with aspects of the presentinvention is preferably formed on a raschel knitting machine such asComez DNB/EL-800-8B set up in 10 gg needle spacing by the use of threemovements as shown in pattern layout in FIGS. 29B-E: two movements inthe wale direction, the vertical direction within the fabric, and onemovement in the course direction, the horizontal direction of thefabric. The movements in the wale direction occur on separate needlebeds with alternate yarns; loops that occur on every course arestaggered within repeat. The yarn follows a repeat pattern of3/1-1/1-1/3-3/3 for one of the wale direction movements (see ground bar#4) as shown in FIGS. 30A and B and FIGS. 30C and D and 1/1-1/3-3/3-3/1for the other wale direction movement (see ground bar #7) as shown inFIGS. 32A and B, FIGS. 32 C and D. The interlacing of the loops withinthe fabric allows for one yarn to become under more tension than theother under stress, locking it around the less tensioned yarn; keepingthe fabric from unraveling when cut. The other movement in the coursedirection as shown in FIG. 31 occurs in every few courses creating theporous design of the mesh. These yarns follow a repeat pattern of9/9-9/9-7/7-9/9-7/7-9/9-7/7-9/9-7/7-9/9/-1/1-1/1-3/3-1/1-3/3-1/1-3/3-1/1-3/3-1/1(see ground bar #5) for the course direction movement as shown in FIGS.31A and B and FIGS. 31C and D. The pattern simulation layout of thispattern is rendered with ComezDraw 3 software in FIG. 33 considering ayarn design made with 2 ends of Td (denier count) 20/22 raw silk twistedtogether in the S direction to form a ply with 6 tpi (turns per inch)and further combining three of the resulting ply with 3 tpi. The sameyarn design is used for the movements occurring in the wale and coursedirections. The stitch density or pick count for the mesh in FIG. 33 is40 picks per centimeter considering the total picks count for thetechnical front face and the technical back face of the fabric, or 20picks per cm considering only on the face of the fabric. The operatingparameters are not limited to those described in FIGS. 29B-E, but aremerely the optimum values for the specific yarn design used for thepattern simulation layout of FIG. 33.

FIG. 34A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

Another variation of the mesh in accordance with aspects of the presentinvention is preferably created on a raschel knitting machine such asComez DNB/EL-800-8B set up in 10 gg needle spacing by the use of fourmovements as shown in pattern layout in FIGS. 34B and C and FIGS. 34Dand E: two movements in the wale direction, the vertical directionwithin the fabric, and two movements in the course direction, thehorizontal direction of the fabric. The movements in the wale directionoccur on separate needle beds with alternate yarns; loops that occur onevery course are staggered within repeat. The yarn follows a repeatpattern of 3/1-1/1-1/3-3/3 for one of the wale direction movements asshown in FIGS. 35A-D and 1/1-1/3-3/3-3/1 for the other wale directionmovement as shown in FIGS. 38A-D. The interlacing of the loops withinthe fabric allows for one yarn to be under more tension than the otherunder stress, locking it around the less tensioned yarn; keeping thefabric from unraveling when cut. One of the other two movements in thecourse direction as shown in FIGS. 36A-D occurs in every few coursescreating the porous design of the mesh. These yarns follow a repeatpattern of3/3-3/3-7/7-7/7-3/3-3/3-5/5-5/5-1/1-1/1-5/5-5/5-3/3-3/3-5/5-5/5-3/3-3/3-5/5-5/5for the course direction movement. The other movements in the coursedirection as shown in FIGS. 37A-D occur in every few courses creatingthe openings in the mesh. These yarns follow a repeat pattern of3/3-3/3-5/5-5/5-1/1-1/1-5/5-5/5-3/3-3/3-7/7-7/7-3/3-3/3-5/5-5/5-3/3-3/3-5/5-5/5-3/3for the course direction movement. The pattern simulation layout of thispattern is rendered with ComezDraw 3 software in FIG. 39 considering ayarn design made with 2 ends of Td 20/22 raw silk twisted together inthe S direction to form a ply with 6 tpi and further combining three ofthe resulting ply with 3 tpi. The same yarn design is used for themovements occurring in the wale and course directions. The stitchdensity or pick count for the surgical mesh design in FIG. 39 is 39picks per centimeter considering the total picks count for the technicalfront face and the technical back face of the fabric, or 19.5 picks percm considering only one face of the fabric. The operating parameters arenot limited to those described in FIGS. 34B-E, but just the optimumvalues for the specific yarn design used for the pattern simulationlayout of FIG. 39.

Furthermore, FIG. 39 demonstrates a process improvement for themanufacturing process of the mesh with the pattern layout in FIGS. 34B-E. The improvement consists of a separation area, 36-1, between twoindividual meshes, 36-2 and 36-3. The advantage of the separation areais to provide guidance for the correct length that the mesh needs tomeasure and to provide guidance for the tools necessary for separatingtwo individual surgical meshes. For example in order to achieve the meshlength of 5 cm±0.4 cm, the pattern in FIGS. 34B-E requires repeatingfrom pattern line 1 to pattern line 16 for 112 times followed by arepeat of 2 times from pattern line 17 to pattern line 20.

FIG. 40A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

Another variation of the mesh according to an aspect of the presentinvention is preferably created on a raschel knitting machine such asComez DNB/EL-800-8B set up in 10 gg needle spacing by the use of threemovements as shown in pattern layout in FIGS. 40B-E: two movements inthe wale direction, the vertical direction within the fabric, and onemovement in the course direction, the horizontal direction of thefabric. The movements in the wale direction occur on separate needlebeds with alternate yarns; loops that occur on every course arestaggered within repeat. The yarn follows a repeat pattern of3/1-1/1-1/3-3/3-for one of the wale direction movements shown in FIGS.41A-D and 1/1-1/3-3/3-3/1 for the other wale direction movement as shownin FIGS. 43A-D. The interlacing of the loops within the fabric allowsfor one yarn to be under more tension than the other under stress,locking it around the less tensioned yam; keeping the fabric fromunraveling when cut. The other movement in the course direction which isshown in FIGS. 42A-D occurs in every few courses creating the porousdesign of the mesh. These yarns follow a repeat pattern of9/9-9/9-7/7-9/9-7/7-9/9-7/7-9/9-7/7-9/9-1/1-1/1-3/3-1/1-3/3-1/1-3/3-1/1-3/3-1/1for the course direction movement. The pattern simulation layout of thispattern is rendered with ComezDraw 3 software in FIG. 44 considering ayarn design made with 3 ends of Td 20/22 raw silk twisted together inthe S direction to form a ply with 6 tpi and further combining three ofthe resulting ply with 3 tpi. The same yarn design is used for themovements occurring in the wale and course directions. The stitchdensity or pick count for the mesh in FIG. 44 is 34 picks per centimeterconsidering the total pick count for the technical front face and thetechnical back face of the fabric, or 17 picks per cm considering onlyon the face of the fabric. The operating parameters are not limited tothose described in FIGS. 40B-E, but just the optimum values for thespecific yarn design used for the pattern simulation layout of FIG. 44.

FIG. 45A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

Another variation of the mesh in accordance with another aspect of thepresent invention is preferably created on a raschel knitting machinesuch as Comez DNB/EL-800-8B set up in 5 gg needle spacing by the use ofthree movements as shown in the pattern layout in FIGS. 45B-E: twomovements in the wale direction, the vertical direction within thefabric, and one movement in the course direction, the horizontaldirection of the fabric. The movements in the wale direction occur onseparate needle beds with alternate yarns; loops that occur on everycourse are staggered within repeat. The yarn follows a repeat pattern of3/1-1/1-1/3-3/3-for one of the wale direction movements as shown inFIGS. 46A-D and 1/1-1/3-3/3-3/1 for the other wale direction movement asshown in FIG. 48A-D. The interlacing of the loops within the fabricallows for one yarn to be under more tension than the other understress, locking it around the less tensioned yarn; keeping the fabricfrom unraveling when cut. The other movement in the course direction asshown in FIG. 47A-D occurs in every few courses creating the porousdesign of the mesh. These yarns follow a repeat pattern of15/15-15/15-13/13-15/15-13/13-15/15-13/13-15/15-13/13-15/15/-1/1-1/1-3/3-1/1-3/3-1/1-3/3-1/1-3/3-1/1for the course direction movement. The pattern simulation layout of thispattern is rendered with ComezDraw 3 software in FIG. 49 considering ayarn design made with 2 ends of Td 20/22 raw silk twisted together inthe S direction to form a ply with 6 tpi and further combining three ofthe resulting ply with 3 tpi for the two movements in the waledirection. For the movements in the course direction the yarn design ismade with 3 ends of Td 20/22 raw silk twisted together in the Sdirection to form a ply with 6 tpi and further combining three of theresulting ply with 3 tpi. The stitch density or pick count for the meshdesign in FIG. 49 is 40 picks per centimeter considering the total pickcount for the technical front face and the technical back face of thefabric, or 20 picks per cm considering only on the face of the fabric.The operating parameters are not limited to these described in FIGS.45B-E, but just the optimum values for the specific yarn design used forthe pattern simulation layout of FIG. 49.

FIG. 50A is a photograph of a pattern layout for a silk-based mesh inaccordance with aspects of the present invention.

Another variation of the mesh in accordance with an aspect of thepresent invention may be created on a raschel knitting machine such asComez DNB/EL-800-8B set up in 10 gg needle spacing by the use of threemovements as shown in the pattern layout in FIGS. 50B-E: two movementsin the wale direction, the vertical direction within the fabric, and onemovement in the course direction, the horizontal direction of thefabric. The movements in the wale direction occur on separate needlebeds with alternate yarns; loops that occur on every course arestaggered within repeat. The yarn follows a repeat pattern of3/1-1/1-1/3-3/3-for one of the wale direction movements shown in FIGS.51A-D and 1/1-1/3-3/3-3/1 for the other wale direction movement shown inFIGS. 53A-D. The interlacing of the loops within the fabric allows forone yarn to be under more tension than the other under stress, lockingit around the less tensioned yam; keeping the fabric from unravelingwhen cut. The other movement in the course direction as shown in FIGS.52A-D occurs in every few courses creating the porous design of themesh. These yarns follow a repeat pattern of9/9-9/9-7/7-9/9-7/7-9/9-7/7-9/9-7/7-9/9/-1/1-1/1-3/3-1/1-3/3-1/1-3/3-1/1-3/3-1/1for the course direction movement. The pattern simulation layout of thispattern is rendered with ComezDraw 3 software in FIG. 54 considering ayarn design made with 2 ends of Td 20/22 raw silk twisted together inthe S direction to form a ply with 6 tpi and further combining three ofthe resulting ply with 3 tpi. The same yarn design is used for themovements occurring in the wale and course directions. The stitchdensity or pick count for the mesh in FIG. 54 is 40 picks per centimeterconsidering the total picks count for the technical front and thetechnical back of the fabric, or 20 picks per cm considering only on theface of the fabric. The operating parameters are not limited to thosedescribed in FIGS. 50B-E, but just the optimum values for the specificyarn design used for the pattern simulation layout of FIG. 54.

In embodiments employing silk yarn, the silk yarn may be twisted fromyarn made by 20-22 denier raw silk fibers approximately 40 to 60 μm indiameter. Preferably, raw silk fibers ranging from 10 to 30 deniers maybe employed; however any fiber diameters that will allow the device toprovide sufficient strength are acceptable. Advantageously, a constantyarn size may maximize the uniformity of the surgical mesh mechanicalproperties, e.g. stiffness, elongation, etc., physical and/or biologicalproperties within each region. However, the yarn size may be varied insections of the mesh in order to achieve different mechanical, physicaland/or biological characteristics in the preferred mesh locations.Factors that may be influenced by the size of the yarn include, but arenot limited to: ultimate tensile strength (UTS); yield strength, i.e.the point at which yarn is permanently deformed; percent elongation;fatigue and dynamic laxity (creep); bioresorption rate; and transfer ofcell/nutrients into and out of the mesh.

The knit patterns illustrated in FIGS. 29A, 34A, 40A, 45A and 50Arespectively, may be knit to any width depending upon the knittingmachine and could be knitted with any of the gauges available with thevarious crochet machines or warp knitting machines. Table 1B outlinesthe fabric widths that may be achieved using a different numbers ofneedles on different gauge machines. It is understood that thedimensions in Table 1B are approximate due to the shrink factor of theknitted fabric which depends on stitch design, stitch density, and yarnsize used.

TABLE 1B Needle Knitting Width Count (mm) Gauge From To From To 48 25656 0.53 2997.68 24 2 2826 1.06 2995.56 20 2 2358 1.27 2994.66 18 22123 1.41 2993.43 16 2 1882 1.59 2992.38 14 2 1653 1.81 2991.93 12 21411 2.12 2991.32 10 2 1177 2.54 2989.58 5 2 586 5.08 2976.88

Mesh or scaffold designs in accordance with aspects of the presentinvention may be knitted on a fine gauge crochet knitting machine.Crochet machines capable of manufacturing the mesh in accordance withaspects of the present invention include, but are not limited to, thoseprovided by: Changde Textile Machinery Co., Ltd.; Comez; China TextileMachinery Co., Ltd.; Huibang Machine; Jakob Muller AG; Jingwei TextileMachinery Co., Ltd.; Zhejiang Jingyi Textile Machinery Co., Ltd.;Dongguan Kyang the Delicate Machine Co., Ltd.; Karl Mayer; SanfangMachine; Sino Techfull; Suzhou Huilong Textile Machinery Co., Ltd.;Taiwan Giu Chun Ind. Co., Ltd.; Zhangjiagang Victor Textile; Liba;Lucas; Muller Frick; and Texma.

Mesh or scaffold designs in accordance with aspects of the presentinvention may be knitted on a fine gauge warp knitting machine. Warpknitting machines capable of manufacturing the mesh in accordance withaspects of the present invention include, but are not limited to, thoseprovided by: Comez; Diba; Jingwei Textile Machinery; Liba; Lucas; KarlMayer; Muller Frick; Runyuan Warp Knitting; Taiwan Giu Chun Ind.; FujianXingang Textile Machinery; and Yuejian Group.

Mesh or scaffold designs in accordance with aspects of the presentinvention may be knitted on a fine gauge flat bed knitting machine. Flatbed machines capable of manufacturing the mesh in accordance withaspects of the present invention include, but are not limited to, thoseprovided by: Around Star; Boosan; Cixing Textile Machine; Fengshen;Flying Tiger Machinery; Fujian Hongqi; G & P; Görteks; Jinlong; JP; JyLeh; Kauo Heng Co., Ltd.; Matsuya; Nan Sing Machinery Limited; NantongSansi Instrument; Shima Seiki; Nantong Tianyuan; and Ningbo YurenKnitting.

A test method was developed to check the cutability of the surgical meshformed according to aspects of the present invention. In the testmethod, the surgical mesh evaluated according to the number of wereneeded to cut the mesh with surgical scissors. The mesh was found to cutexcellently because it took one scissor stroke to cut through it. Themesh was also cut diagonally and in circular patterns to determine howeasily the mesh unraveled and how mush it unraveled once cut. The meshdid not unravel more than one mode after being cut in both directions.To determine further if the mesh would unravel, a suture, was passedthrough the closest pore from the cut edge, and pulled. Thismanipulation did not unravel the mesh. Thus, the surgical mesh is easyto cut and does not unravel after manipulation.

Embodiments may be processed with a surface treatment, which increasesmaterial hydrophilicity, biocompatibility, physical, and mechanicalproperties such as handling for ease of cutting and graft pull-through,as well as anti-microbial and anti-fungal coatings. Specific examples ofsurface treatments include, but are not limited to:

-   -   plasma modification    -   protein such as but not limited to fibronectin, denatured        collagen or gelatin, collagen gels and hydrophobin by covalent        link or other chemical or physical method    -   peptides with hydrophilic and a hydrophobic end    -   peptides contain one silk-binding sequence and one biologically        active sequence—biodegradable cellulose    -   surface sulfonation    -   ozone gas treatment    -   physically bound and chemically stabilized peptides    -   DNA/RNA aptamers    -   Peptide Nucleic Acids    -   Avimers    -   modified and unmodified polysaccharide coatings    -   carbohydrate coating    -   anti-microbial coatings    -   anti-fungal coatings    -   phosphorylcholine coatings

A method to evaluate the ease of delivery through a cannula was done tomake sure the surgical mesh could be used laparoscopically. Variouslengths were rolled up and pushed through two different standard sizedcannulas using surgical graspers. The mesh was then evaluated todetermine if there was any damage done to the mesh. The mesh that wasput through the cannulas was found to have slight distortion to thecorner that was held by the grasper. The 16 cm and 18 cm lengths of meshthat were rolled up and pushed through the 8 mm cannula had minimalfraying and one distorted pore, respectively. It was also found that nodamage was done to the cannula or septum in any of the tests. It wasfound that appropriately sized surgical mesh will successfully passthrough a laparoscopic cannula without damage, enabling its effectiveuse during laparoscopic procedures.

A surgical mesh device according to aspects of the present invention hasbeen found to bio-resorb by 50% in approximately 100 days. In a study byHoran et al., Sprague-Dawley rats were used to compare thebio-resorption of embodiments according to the present invention toMersilene™ mesh (Ethicon, Somerville, N.J.). The histology reports fromthe article state that after 94 days, 43% of the initial mesh of theembodiments remained compared to 96% of the Mersilene™ mesh. It was alsoreported that the in growth was more uniform with the mesh ofembodiments than the Mersilene™ mesh. The Mersilene™ was found to haveless in growth in the defect region than along the abdominal wall.

Physical properties include thickness, density and pore sizes. Thethickness was measured utilizing a J100 Kafer Dial Thickness Gauge. AMitutoyo Digimatic Caliper was used to find the length and width of thesamples; used to calculate the density. The density was found bymultiplying the length, width and thickness of the mesh then dividingthe resulting value by the mass. The pore size was found byphotographing the mesh with an Olympus SZX7 Dissection Microscope under0.8× magnification. The measurements were taken using ImagePro 5.1software and the values were averaged over several measurements. Thephysical characteristics of the sample meshes, including embodimentsaccording to the present invention, are provided in TABLE 2.

TABLE 2 Physical Characterization Thickness Pore Size Device (mm) (mm²)Density (g/cm³) Mersilene Mesh 0.31 ± 0.01 0.506 ± 0.035 0.143 ± 0.003Bard Mesh 0.72 ± 0.00 0.465 ± 0.029 0.130 ± 0.005 Vicryl Knitted Mesh0.22 ± 0.01 0.064 ± 0.017 0.253 ± 0.014 Present Embodiments -  1.0 ±0.04 0.640 ± 0.409 0.176 ± 0.002 Single Needle Bed (SB) PresentEmbodiments - 0.80 ± 0.20 1.27 0.135-0.165 Double Needle Bed (DB)

All devices were cut to the dimensions specified in TABLE 3, for eachtype of mechanical analysis. Samples were incubated in phosphatebuffered saline (PBS) for 3±1.25 hours at 37±2° C. prior to mechanicalanalysis to provide characteristics in a wet environment. Samples wereremoved from solution and immediately tested.

TABLE 3 Test Modality Length (mm) Width (mm) Tensile 60 10 Burst 32 32Suture Pull-Out 40 20 Tear 60 40 Tensile Fatigue 60 40

Ball burst test samples were scaled down due to limitations in materialdimensions. The test fixture employed was a scaled (1:2.5) version ofthat recommended by ASTM Standard D3787. The samples were centeredwithin a fixture and burst with a 10 mm diameter ball traveling at adisplacement rate of 60 mm/min. Maximum stress and stiffness weredetermined from the burst test. Results can be seen in TABLE 4.

TABLE 4 Burst Strength Device Stress (MPa) Stiffness (N/mm) MersileneMesh 0.27 ± 0.01 13.36 ± 0.85 Bard Mesh 0.98 ± 0.04 38.28 ± 1.49 VicrylKnitted Mesh 0.59 ± 0.05 32.27 ± 1.86 Pelvitex Polypropylene Mesh 0.59 ±0.04 29.78 ± 1.33 Permacol Biologic Implant 1.27 ± 0.27 128.38 ± 22.14Present Embodiments (SB) 0.76 ± 0.04 46.10 ± 2.16 Present Embodiments(DB) 0.66 40.9

Tensile tests were preformed along the fabric formation and width axesof each device. A 1 cm length of mesh on each end of the device wassandwiched between pieces of 3.0 mm thick silicone sheet and mounted inpneumatic fabric clamps with a clamping pressure of 70-85 psi. Sampleswere loaded through displacement controlled testing at a strain rate of100%/s (2400 mm/min) and or 67%/s (1600 mm/min) until failure. Theultimate tensile strength (UTS), linear stiffness and percent elongationat break can be seen in the following tables. Results can be found inTABLES 5-8. An entry of “NT” indicates that the data has not yet beentested.

TABLE 5 Tensile SPTF (Fabric Formation Axis-1600 mm/min) Strength StressStiffness % Elong. @ Device (N) (MPa) (N/mm) Break Mersilene 46.14 ±3.15 10.04 ± 0.71 0.90 ± 0.06 132.1% ± 9.3% Mesh Bard Mesh 30.90 ± 2.0 16.64 ± 1.16 3.32 ± 0.26 106.5% ± 3.2% Vicryl 35.69 ± 3.30 35.89 ± 4.482.59 ± 0.33  89.0% ± 7.3% Knitted Mesh Present 76.72 ± 4.36 10.06 ± 0.387.13 ± 0.50  41.5% ± 2.3% Embo- diments (SB) Present NT NT NT NT Embo-diments Mesh (DB)

TABLE 6 Tensile SPTF (Fabric Formation Axis-2400 mm/min) Strength StressStiffness % Elong. @ Device (N) (MPa) (N/mm) Break Mersilene Mesh 43.87± 5.19 14.15 ± 1.68  2.18 ± 0.3  56.6% ± 3.5% Bard Mesh 35.29 ± 5.694.90 ± 0.79 0.80 ± 0.23 177.3% ± 13.2% Vicryl Knitted 30.88 ± 3.30 14.04± 1.50  0.76 ± 0.17 191.9% ± 14.2% Mesh Pelvite 23.05 ± 3.75 5.36 ± 0.870.57 ± 0.07 110.0% ± 13.6% Polypropylene Mesh Permacol 164.52 ± 30.5813.71 ± 2.55  23.94 ± 2.7  23.5% ± 3.3% Biologic Implant Present 72.31 ±7.80 6.95 ± 0.75 4.31 ± 0.3  45.5% ± 5.2% Embodiments (SB) Present 74.62± 2.70 8.68 ± 0.31 4.25 ± 0.13 48.3% ± 2.1% Embodiments (DB)

TABLE 7 Tensile SPTF (Fabric Width Axis-2400 mm/min) Strength StressStiffness % Elong. @ Device (N) (MPa) (N/mm) Break Mersilene Mesh  31.14± 2.21 10.04 ± 0.71 0.90 ± 0.06 132.1% ± 9.3% Bard Mesh 119.80 ± 8.3616.64 ± 1.16 3.32 ± 0.26 106.5% ± 3.2% Vicryl Knitted Mesh  78.96 ± 9.8635.89 ± 4.48 2.59 ± 0.33  89.0% ± 7.3% Present 104.58 ± 3.96 10.06 ±0.38 7.13 ± 0.50  41.5% ± 2.3% Embodiments (SB) Present NT NT NT NTEmbodiments (DB)

TABLE 8 Tensile SPTF (Fabric Width Axis-2400 mm/min) Strength StressStiffness % Elong. @ Device (N) (MPa) (N/mm) Break Mersilene Mesh 28.11± 2.93 28.11 ± 2.93   1.05 ± 0.13 128.2% ± 23.6% Bard Mesh 103.53 ±8.92  14.38 ± 1.24  3.43 ± 0.5 94.0% ± 8.4% Vicryl Knitted 106.65 ±8.46  48.48 ± 3.85  5.08 ± 0.1 58.6% ± 8.4% Mesh Pelvite 30.24 ± 5.777.03 ± 1.34 1.48 ± 0.1 89.6% ± 9.6% Polypropylene Mesh Permacol  67.71 ±13.36 5.64 ± 1.11 8.56 ± 2.0 27.4% ± 4.2% Biologic Implant Present 98.84± 4.79 9.50 ± 0.46 8.48 ± 0.3 39.0% ± 4.1% Embodiments (SB) Present70.08 ± 2.55 8.15 ± 0.30 5.87 ± 0.22 33.6% ± 2.0% Embodiments (DB)

Tear Strength was found through a method that entailed cutting a 10 mm“tear” into the edge, perpendicular to the long axis edge and centeredalong the length of the mesh. The mesh was mounted in pneumatic fabricclamps as previously described in the tensile testing methods. Sampleswere loaded through displacement controlled testing at a strain rate of100%/s (2400 mm/min) until failure. The load at failure and the mode offailure are shown in TABLE 9.

TABLE 9 Tear Strength Device Strength (N) Failure Mode Mersilene Mesh110.30 ± 5.63 Tear Failure: 6/6 Bard Mesh  181.70 ± 12.33 Tear Failure:6/6 Vicryl Knitted Mesh 109.35 ± 4.85 Tear Failure: 6/6 PelvitexPolypropylene Mesh 108.14 ± 6.95 Tear Failure: 4/6 Permacol BiologicImplant  273.79 ± 65.57 Tear Failure: 6/6 Embodiments (SB) 194.81 ± 9.12Tear Failure: 6/6 Embodiments (DB) NT NT

Tensile fatigue testing was preformed on the surgical mesh deviceaccording to aspects of the present invention and representativepredicate types including Vicryl Mesh and Bard Mesh. Samples were loadedinto the pneumatic fabric clamps as previously described in the tensiletesting methods above. Samples were submerged in PBS at room temperatureduring cycling. Sinusoidal load controlled cycling was preformed to 60%of mesh ultimate tensile strength. Number of cycles to failure wasdetermined during the cyclic studies and can be seen in TABLE 10, wherefailure was indicated by fracture or permanent deformation in excess of200%.

TABLE 10 Tensile Fatigue Device Cycles, 60% UTS Bard Mesh 6994 ± 2987Vicryl Knitted Mesh  91 ± 127 Embodiments (DB) 1950 ± 1409

A method was developed to compare the suture pull out strength of thesurgical mesh device according to aspects of the present invention toother surgical mesh on the market. Tested mesh was sutured with three3.5 mm diameter suture anchors (Arthrex, Naples, Fla.) and secured to 15pcf solid rigid polyurethane foam. Each device was positioned with thecenter of the 20 mm width over the center anchor with a 3 mm suture bitedistance employed during suturing of the mesh to the 3 anchors. The sawbone was mounted in the lower pneumatic fabric clamp and offset toprovide loading along the axis of the device when the device wascentered under the load cell. The free end of the mesh was sandwichedbetween the silicone pieces and placed in the upper fabric clamp with85±5 psi clamping force. Testing was preformed under displacementcontrol with a strain rate of 100%/s (1620 mm/min). Maximum load atbreak and failure mode can be seen in TABLE 11.

TABLE 11 Suture-Pull-Out Device Strength/Suture [N] Failure ModeMersilene Mesh 13.50 ± 1.65 Mesh Failure: 6 of 6 Bard Mesh 28.80 ± 3.39Mesh Failure: 6 of 6 Vicryl Knitted Mesh 12.90 ± 1.30 Mesh Failure: 6 of6 Pelvitex Polyproplene Mesh 18.29 ± 4.04 Mesh Failure: 6 of 6 PermacolBiologic Implant 47.36 ± 7.94 Mesh Failure: 6 of 6 Embodiments (SB)41.00 ± 2.98 Mesh Failure: 6 of 6 Embodiments (DB) 32.57 ± 2.30 MeshFailure: 6 of 6

By utilizing the pattern for the double needle bed mesh and modifyingthe yarn size, yarn feed rate and/or needle bed width, the surgical meshdevice according to aspects of the present invention would meet thephysical and mechanical properties necessary for a soft or hard tissuerepair depending on the application. Such properties include pore size,thickness, ultimate tensile strength, stiffness, burst strength andsuture pull out. The pore size could be modified dependent to the feedrate to create a more open fabric and the thickness could range from0.40 mm up to as wide as 19.0 mm. With modifications to the pore sizeand thickness the UTS, stiffness, burst strength and suture pull outwould all be modified as well, most likely tailoring the modificationsof the pore size and/or thickness to meet certain mechanical needs.

This mesh, created on the flat knitting machine would be made in such away to increase or decrease pore size and/or thickness by changing theyarn size and/or changing the loop length found within the knittingsettings. The loop placements in combination with the node lock designallow changes to the shape and/or to the mechanical properties of themesh. A biocompatible yarn with elasticity, such as highly twisted silk,could be used for shaping.

The implantation of a mesh and subsequent testing according to aspectsof the present invention is illustrated in FIGS. 21A-D. FIG. 21Aillustrates a full-thickness rat abdominal defect created using a customdesigned 1-cm stainless steel punch. The defect appears oval in shapedue to body wall tension applied. FIG. 21B illustrates a 4 cm×4 cmimplant centered on top of the open defect, and held in place withsingle interrupted polypropylene sutures (arrow) through the implant andmuscle. FIG. 21C illustrates an explanted specimen 94 days postimplantation. FIG. 21D illustrates ball burst testing performed with a1-cm diameter ball pushed through the defect site reinforced with themesh.

While the present invention has been described in connection with anumber of exemplary embodiments, and implementations, the presentinventions are not so limited, but rather cover various modifications,and equivalent arrangements. For example, a knitted mesh according toaspects of the present invention may be used for a filler material. Inone application, the knitted mesh may be cut into 1 mm×1 mm sections toseparate one or more nodes, e.g., 3 nodes. The sections may be added tofat tissue or a hydro-gel to form a solution that can be injected into adefective area. Advantageously, the filler material may provide adesired texture, but will not unravel.

What is claimed is:
 1. A method of knitting an implantable surgical meshcomprising: knitting a first yarn in a jersey stitch in a coursedirection, tucking at spaced needle positions a second yarn in a loopformed by the jersey stitch of the first yarn to lockingly engage theyarns in place in a manner that substantially deters disengagement ofthe yarns from each other when tension is applied to the fabric when thefabric mesh is cut, wherein the first and second yarns aredifferentially engaged according to differential physical properties. 2.The method according to claim 1, wherein at least one yarn is silk.
 3. Amethod of using an implantable surgical mesh, the method comprising:providing a fabric comprised of at least two yarns differentiallyengaging each other in a defined pattern to form a plurality ofinterconnections at each of which the yarns lockingly engage in a mannerthat substantially deters disengagement of the yarns from each otherwhen tension is applied to the fabric when the fabric mesh is cut, andimplanting the fabric mesh in a human body.
 4. The method according toclaim 3, wherein the defined pattern provides a plurality of openings topromote tissue in-growth.
 5. The method according to claim 3, wherein atleast one yarn is silk.
 6. The method according to claim 3, wherein thefabric is a knit.
 7. The method according to claim 3, wherein at leasttwo of the yarns are knitted in opposing stitch patterns.